diff --git a/README.md b/README.md
index 50851f7..c746c63 100644
--- a/README.md
+++ b/README.md
@@ -38,6 +38,39 @@ command-line option.
 --loader=import-in-the-middle/hook.mjs
 ```
 
+It's also possible to register the loader hook programmatically via the Node
+[`module.register()`](https://nodejs.org/api/module.html#moduleregisterspecifier-parenturl-options)
+API. However, for this to be able to hook non-dynamic imports, it needs to be
+loaded before your app code is evaluated via the `--import` command-line option.
+
+`my-loader.mjs`
+```js
+import * as module from 'module'
+
+module.register('import-in-the-middle/hook.mjs', import.meta.url)
+```
+```shell
+node --import=./my-loader.mjs ./my-code.mjs
+```
+
+When registering the loader hook programmatically, it's possible to pass a list
+of modules or file URLs to either exclude or specifically include which modules
+are intercepted. This is useful if a module is not compatible with the loader
+hook. 
+```js
+import * as module from 'module'
+
+// Exclude intercepting a specific module by name
+module.register('import-in-the-middle/hook.mjs', import.meta.url, {
+  data: { exclude: ['package-i-want-to-exclude'] }
+})
+
+// Only intercept a specific module by name
+module.register('import-in-the-middle/hook.mjs', import.meta.url, {
+  data: { include: ['package-i-want-to-include'] }
+})
+```
+
 ## Limitations
 
 * You cannot add new exports to a module. You can only modify existing ones.
diff --git a/hook.js b/hook.js
index 4b6caee..1752bcf 100644
--- a/hook.js
+++ b/hook.js
@@ -116,6 +116,38 @@ function isBareSpecifier (specifier) {
   }
 }
 
+function isBareSpecifierOrFileUrl (input) {
+  // Relative and absolute paths
+  if (
+    input.startsWith('.') ||
+    input.startsWith('/')) {
+    return false
+  }
+
+  try {
+    // eslint-disable-next-line no-new
+    const url = new URL(input)
+    return url.protocol === 'file:'
+  } catch (err) {
+    // Anything that fails parsing is a bare specifier
+    return true
+  }
+}
+
+function ensureArrayWithBareSpecifiersAndFileUrls (array, type) {
+  if (!Array.isArray(array)) {
+    return undefined
+  }
+
+  const invalid = array.filter(s => !isBareSpecifierOrFileUrl(s))
+
+  if (invalid.length) {
+    throw new Error(`'${type}' option only supports bare specifiers and file URLs. Invalid entries: ${inspect(invalid)}`)
+  }
+
+  return array
+}
+
 function emitWarning (err) {
   // Unfortunately, process.emitWarning does not output the full error
   // with error.cause like console.warn does so we need to inspect it when
@@ -217,6 +249,14 @@ function addIitm (url) {
 function createHook (meta) {
   let cachedResolve
   const iitmURL = new URL('lib/register.js', meta.url).toString()
+  let includeModules, excludeModules
+
+  async function initialize (data) {
+    if (data) {
+      includeModules = ensureArrayWithBareSpecifiersAndFileUrls(data.include, 'include')
+      excludeModules = ensureArrayWithBareSpecifiersAndFileUrls(data.exclude, 'exclude')
+    }
+  }
 
   async function resolve (specifier, context, parentResolve) {
     cachedResolve = parentResolve
@@ -234,14 +274,27 @@ function createHook (meta) {
     if (isWin && parentURL.indexOf('file:node') === 0) {
       context.parentURL = ''
     }
-    const url = await parentResolve(newSpecifier, context, parentResolve)
-    if (parentURL === '' && !EXTENSION_RE.test(url.url)) {
-      entrypoint = url.url
-      return { url: url.url, format: 'commonjs' }
+    const result = await parentResolve(newSpecifier, context, parentResolve)
+    if (parentURL === '' && !EXTENSION_RE.test(result.url)) {
+      entrypoint = result.url
+      return { url: result.url, format: 'commonjs' }
+    }
+
+    // For included/excluded modules, we check the specifier to match libraries
+    // that are loaded with bare specifiers from node_modules.
+    //
+    // For non-bare specifier imports, we only support matching file URL strings
+    // because using relative paths would be very error prone!
+    if (includeModules && !includeModules.some(lib => lib === specifier || lib === result.url.url)) {
+      return result
+    }
+
+    if (excludeModules && excludeModules.some(lib => lib === specifier || lib === result.url.url)) {
+      return result
     }
 
     if (isIitm(parentURL, meta) || hasIitm(parentURL)) {
-      return url
+      return result
     }
 
     // Node.js v21 renames importAssertions to importAttributes
@@ -249,24 +302,24 @@ function createHook (meta) {
       (context.importAssertions && context.importAssertions.type === 'json') ||
       (context.importAttributes && context.importAttributes.type === 'json')
     ) {
-      return url
+      return result
     }
 
     // If the file is referencing itself, we need to skip adding the iitm search params
-    if (url.url === parentURL) {
+    if (result.url === parentURL) {
       return {
-        url: url.url,
+        url: result.url,
         shortCircuit: true,
-        format: url.format
+        format: result.format
       }
     }
 
-    specifiers.set(url.url, specifier)
+    specifiers.set(result.url, specifier)
 
     return {
-      url: addIitm(url.url),
+      url: addIitm(result.url),
       shortCircuit: true,
-      format: url.format
+      format: result.format
     }
   }
 
@@ -337,9 +390,10 @@ register(${JSON.stringify(realUrl)}, _, set, ${JSON.stringify(specifiers.get(rea
   }
 
   if (NODE_MAJOR >= 17 || (NODE_MAJOR === 16 && NODE_MINOR >= 12)) {
-    return { load, resolve }
+    return { initialize, load, resolve }
   } else {
     return {
+      initialize,
       load,
       resolve,
       getSource,
diff --git a/hook.mjs b/hook.mjs
index 7e21d84..37acec3 100644
--- a/hook.mjs
+++ b/hook.mjs
@@ -4,6 +4,6 @@
 
 import { createHook } from './hook.js'
 
-const { load, resolve, getFormat, getSource } = createHook(import.meta)
+const { initialize, load, resolve, getFormat, getSource } = createHook(import.meta)
 
-export { load, resolve, getFormat, getSource }
+export { initialize, load, resolve, getFormat, getSource }
diff --git a/package.json b/package.json
index 093a6e7..bed6728 100644
--- a/package.json
+++ b/package.json
@@ -4,7 +4,7 @@
   "description": "Intercept imports in Node.js",
   "main": "index.js",
   "scripts": {
-    "test": "c8 --reporter lcov --check-coverage --lines 50 imhotap --files test/{hook,low-level,other,get-esm-exports}/*",
+    "test": "c8 --reporter lcov --check-coverage --lines 50 imhotap --files test/{hook,low-level,other,get-esm-exports,register}/*",
     "test:e2e": "node test/check-exports/test.mjs",
     "test:ts": "c8 --reporter lcov imhotap --files test/typescript/*.test.mts",
     "coverage": "c8 --reporter html imhotap --files test/{hook,low-level,other,get-esm-exports}/* && echo '\nNow open coverage/index.html\n'",
diff --git a/test/generic-loader.mjs b/test/generic-loader.mjs
index 8d02761..ff49f67 100644
--- a/test/generic-loader.mjs
+++ b/test/generic-loader.mjs
@@ -8,7 +8,7 @@ import path from 'path'
 
 const filename = process.env.IITM_TEST_FILE
 
-export const { load, resolve, getFormat, getSource } =
-  filename.includes('disabled')
+export const { initialize, load, resolve, getFormat, getSource } =
+  filename.includes('disabled') || filename.includes('register')
     ? {}
     : (path.extname(filename).slice(-2) === 'ts' ? tsLoader : regularLoader)
diff --git a/test/register/v18.19-exclude.mjs b/test/register/v18.19-exclude.mjs
new file mode 100644
index 0000000..73105ce
--- /dev/null
+++ b/test/register/v18.19-exclude.mjs
@@ -0,0 +1,15 @@
+import { register } from 'module'
+import Hook from '../../index.js'
+import { strictEqual } from 'assert'
+
+register('../../hook.mjs', import.meta.url, { data: { exclude: ['util'] } })
+
+const hooked = []
+
+Hook((exports, name) => {
+  hooked.push(name)
+})
+
+await import('openai')
+
+strictEqual(hooked.includes('util'), false)
diff --git a/test/register/v18.19-include.mjs b/test/register/v18.19-include.mjs
new file mode 100644
index 0000000..7ba2c72
--- /dev/null
+++ b/test/register/v18.19-include.mjs
@@ -0,0 +1,16 @@
+import { register } from 'module'
+import Hook from '../../index.js'
+import { strictEqual } from 'assert'
+
+register('../../hook.mjs', import.meta.url, { data: { include: ['openai'] } })
+
+const hooked = []
+
+Hook((exports, name) => {
+  hooked.push(name)
+})
+
+await import('openai')
+
+strictEqual(hooked.length, 1)
+strictEqual(hooked[0], 'openai')